Granulomatous appendicitis revisited: Report of a case

Background. Isolated granulomatous appendicitis is uncommon and previously was considered to be a form of localised Crohn's disease. However more rece nt series have noted that relapse is rare after appendicectomy and conclude d that the condition is a distinct entity unrelated to Crohn's disease. Fol lowing a case of granulomatous appendicitis at St. Vincent's University Hos pital Dublin,the condition was reviewed and the results are detailed herein . Methods:A case of granulomatous appendicitis is presented with discussion of 4 previous cases encountered in our practice and the literature is revi ewed. Results:The clinical presentation was sub-acute appendicitis with a m ass palpable in the right iliac fossa. At operation an enlarged, inflamed a ppendix with a broad base was noted and appendicectomy performed. Histopath ology showed numerous granulomata on microscopic examination. The yersinia serology tests were negative. Review of computerised histopathology records in the hospital for the last 7 years showed 4 additional cases of granulom atous appendicitis. This is a total of 5 of 1,615 appendicectomies (an inci dence of 0.31%). In all cases, the post-operative course was uneventful and the patients have had no further complaints. Conclusion: This small series provides further evidence that granulomatous appendicitis is a distinct cl inical entity unrelated to Crohn's disease and is cured by appendicectomy. It should be suspected when there is a sub-acute onset of appendicitis and an enlarged, broad-based appendix is found at operation. Copyright (C) 2001 S. Karger AG, Basel.